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Dengue Virus

Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. Dengue fever is most commonly seen in Southeast Asia and the Caribbean. Within the United States, the disease is endemic in Puerto Rico and outbreaks have occurred in Key West, Florida.

The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission. Indigenous transmission has been documented in Texas. Dengue fever is caused by any of four closely related members of the Flavivirus family.

Infection with dengue virus may manifest as either dengue fever or the more severe dengue hemorrhagic fever. Dengue fever is a self-limited febrile illness that is characterized by high fever, lasting 2 to 7 days, plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. A low white blood cell count is common. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of Dengue fever consists of symptomatic treatment and monitoring for the development of severe disease at or around the time of defervescence.

A small proportion of patients develop Dengue hemorrhagic fever, which is characterized by presence of resolving fever or a recent history of fever, thrombocytopenia, bleeding and increased vascular permeability evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. Dengue hemorrhagic fever can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids.

Specimens from patients with acute febrile illness who returned from dengue-affected areas within the past 14 days should be submitted for testing. Accuracy is increased when both acute and convalescent specimens are available for testing. Providers should submit acute specimens as soon as they are available and then submit the convalescent specimen later. The preferred specimen depends on the stage of the illness.

Specimen

Days from Onset

Preferred Test

Acute

0 – 5

RT-PCR

Convalescent

6 – 30

Dengue IgM

Real time polymerase chain reaction (RT-PCR) can detect all four serotypes of the Dengue virus.

 

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